NIA AD/ADRD Health Care Systems Research Collaboratory

摘要 2019冠状病毒病（COVID）大流行对长期护理居民的影响不成比例 在美国，目前占全国病例的7%，但占死亡人数的40%。截至11月下旬， 10万居民死亡，但不完整的数据意味着这些是低估。专业护理设施 （SNF）为医疗复杂的老年人提供急性后和长期护理，其中约70%的人 患有阿尔茨海默病和相关痴呆症（ADRD），特别容易受到SARS-CoV-2的影响。 SARS-CoV-2代表了几十年来对SNF的最严重挑战，因为它的致命性和容易感染性。 传播，尤其是无症状携带者。开发适当的临床和 在减轻这一流行病影响的业务对策方面，缺乏全面的数据。虽然中心 医疗保险和医疗补助服务（CMS）和疾病控制和预防中心（CDC）创建 数据报告系统，这些设施级数据不足以了解哪些居民获得COVID 或住院医师水平的临床结果。目前的监测数据没有提供死亡率或死亡率的预测因素。 自2020年春季以来，随着病死率的下降，这些预测因素是否发生了变化。 了解COVID（以及未来类似的公共卫生威胁）的国家影响，一个更大，更丰富， 需要有全国代表性的SNF数据库。这个数据库是特别重要的，因为居民 将接种COVID疫苗，但关于体弱的老年人可能会经历的不良反应的信息很少， 比这些疫苗临床试验中纳入的人群发生率更高或严重程度更高。 与美国医疗保健协会（AHCA）和两个技术合作伙伴合作， IMPACT合作实验室[U 54 AG 063546]将：1）收集详细的电子 从大约10，000个美国疗养院收集医疗记录数据，然后将这些记录与Medicare合并， 声称，创建定期更新的数据基础设施，以解决与以下相关的临床和政策问题 COVID（但可能适用于未来情况），例如：2）COVID的累积发病率是多少 在少数民族和ADRD居民中？3)人口统计学，临床，组织， 区域因素对养老院居民COVID？发病率和死亡率的影响; 4)这 养老院居民接种了COVID疫苗，患有ADRD和/或少数民族的人不太可能 接种疫苗？和5）2019年之间身体和认知功能下降的比率是否增加 和2020年在ADRD居民中，独立于COVID感染？数据基础设施将 革命性地快速监测养老院的新感染和治疗趋势，并创建一个大的， 用于量化联邦和州政策变化的直接和间接影响的详细数据库。

ABSTRACT The Coronavirus Disease 2019 (COVID) pandemic has disproportionately affected long-term care residents in the US, who currently represent 7% of cases nationwide, but 40% of deaths. As of late November, over 100,000 residents have died, but incomplete data means these are undercounts. Skilled nursing facilities (SNFs) provide a mix of post-acute and long-term care to medically-complex older adults, about 70% of whom have Alzheimer’s Disease and Related Dementias (ADRD) and are particularly vulnerable to SARS-CoV-2. SARS-CoV-2 represents the most serious challenge to SNFs in decades because of its lethality and ease of transmission, especially by asymptomatic carriers. A major barrier to developing appropriate clinical and operational responses to mitigate the pandemic’s effects is the lack of comprehensive data. While the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) created data reporting systems, these facility-level data are insufficient to understand which residents acquire COVID or resident-level clinical outcomes. The current surveillance data offer no insight into predictors of mortality or whether these predictors have changed as the case fatality has declined since Spring of 2020.To truly understand the national impact of COVID (and similar future public health threats), a much larger, richer, and nationally representative database of SNFs is needed. This database is particularly important since residents will be vaccinated for COVID with little information on adverse effects that frail older adults may experience at higher rates or greater severity than the populations that were included in the clinical trials for these vaccines . Working with the American Health Care Association (AHCA) and two technology partners, this supplement to the IMPACT Collaboratory [U54 AG063546] will: 1) assemble an integrated database of detailed, electronic medical records data from some 10,000 US nursing homes and then merge these records with Medicare claims, creating a regularly updated data infrastructure to address clinical and policy questions pertaining to COVID (but which could apply to future conditions) such as: 2) What is the cumulative incidence of COVID among racial minorities and residents with ADRD?; 3) What influence do demographic, clinical, organizational, and regional factors have on nursing home residents’ risk of morbidity and mortality from COVID?; 4) Which nursing home residents are vaccinated against COVID and are those with ADRD and/or minorities less likely to be vaccinated?; and 5) Have the rates of physical and cognitive functional decline increased between 2019 and 2020 among residents living with ADRD, independent of COVID infection? This data infrastructure will revolutionize the rapid monitoring of nursing home trends in new infections and treatments and create a large, detailed database for quantifying the direct and indirect effects of federal and state policy changes.